NURS FPX 6021 Assessment 2 Change Strategy and Implementation

Name

Capella university

NURS-FPX 6021 Biopsychosocial Concepts for Advanced Nursing Practice 1

Prof. Name

Date

Change Strategy and Implementation

Renal failure manifests when the kidneys fail their capacity to efficiently eliminate unwanted produces and surplus fluids from the bloodstream (Nagendra et al., 2023). This evaluation concentrates on crafting personalized healthcare tactics for Mrs. Smith, a 52-year-old individual grappling with Type II Diabetes Mellitus and Acute Renal Failure (Capella University, 2024). Engaging evidence-derived methodologies and collaborative interprofessional efforts, our objective is to enrich her treatment, prioritizing safety, fairness, and outcomes centered around the patient.

Data Table

The current state and desired outcomes are given below in the table. Change strategies are founded on recommendations from the American Diabetes Association (ADA) and the North American Nursing Diagnosis Association (NANDA), guaranteeing a complete and evidence-based method to improve Mrs. Smith’s health outcomes (ADA, 2022; NANDA, 2020). The data is Health Insurance Portability and Accountability Act (HIPAA) compliant, confirming privacy and confidentiality.

Table 1: Clinical Outcomes Assessment

Clinical Outcome	Current State	Desired State
Blood Glucose Levels	For Mrs Smith, fasting: 125 mg/dL Postprandial: 140 mg/dL Occasional spikes up to 200-350 mg/dL In the current setting, 60% of diabetic patients have insulin spike issues.	Consistently within the range of 80-130 mg/dL fasting and less than 180 mg/dL postprandial (Lin et al., 2021). Overall around 50% reduction in insulin spike is desired.
Renal Function	In Mrs Smith case, mild leg edema and Blood tests indicating early stages of renal damage In the current setting around 30% of patients have improper renal function.	No leg edema Improved renal function tests Regular urine output with normal parameters (ADA, 2022). Overall 20% improvement in renal functions is desired.
Self-Care and Social Support	For Mrs Smith, inconsistent dietary management Dependent on daughter for evening care and limited social interactions In the current setting, around 40% of patients are not able to self-care.	Improved dietary management Increased social engagement. Overall 95% patients are expected to be able to self-care (Martens et al., 2021).
Medication Adherence	Limited financial resources impacting Mrs Smith’s medication adherence. In the current setting, around 70% of patients are having financial issues.	Consistent medication adherence No financial barriers It is desired that about 90% of patients are given financial assistance (Laursen et al., 2021).

Areas of Ambiguity/Uncertainty

Additional data on Mrs Smith’s dietary habits and physical activity levels could help clarify factors contributing to her blood glucose spikes. More detailed information on her medication adherence patterns and financial constraints would aid in tailoring financial assistance programs effectively. Further assessment of her social support network could identify gaps that impact her self-care and well-being (Lin et al., 2021).

Change Strategies for Desired Outcomes

To attain the desired outcomes for Mrs. Smith and the overall patient setting, I propose the following change strategies. For Mrs. Smith, implementing Continuous Glucose Monitoring (CGM) will help maintain optimal blood glucose levels. Comprehensive diabetes education focusing on diet and lifestyle changes will also be essential (Martens et al., 2021). In the broader setting, aiming for a 50% reduction in insulin spikes can be achieved by standardizing CGM use and dietary education for all diabetic patients. Administering diuretics as prescribed will help manage Mrs. Smith’s renal function.

For the overall patient population, regular monitoring and early intervention for those showing signs of renal dysfunction can lead to a 20% improvement in renal functions (ADA, 2022). Coordinated care involving nephrologists and regular check-ups will be essential. For Mrs. Smith, ensuring dietary management and social engagement will involve collaborating with dietitians and social workers. For the broader patient group, creating support groups and educational workshops can help increase self-care capability to 95%. Engaging family members will be vital to support these efforts (Do et al., 2020).

Addressing Mrs. Smith’s financial barriers to medication adherence will involve connecting her with financial assistance programs and simplifying her medication regimen. For the overall setting, ensuring that 90% of patients receive financial support can be achieved by establishing partnerships with community organizations and charitable programs (Laursen et al., 2021). Implementing these strategies will require a multidisciplinary team, including endocrinologists, dietitians, nurses, social workers, and nephrologists. Regular check-ins will monitor progress and adjust care plans as needed. Coordination with community resources will support dietary needs and medication costs.

Challenges include Mrs. Smith’s financial limitations and potential resistance to lifestyle changes. Engaging her daughter and other support networks will help encourage adherence and provide emotional support. Seeking out community and charitable programs will offer additional financial assistance. Evaluating the efficiency and effectiveness of these interventions will involve regular monitoring of blood glucose levels, renal function, and self-reported adherence to the care plan, ensuring that desired outcomes are met (Sugandh et al., 2023).

Justification of the Change Strategies

The preferred change approaches are essential for effectively addressing Mrs. Smith’s clinical outcomes. Implementing CGM is crucial for maintaining optimal blood glucose levels, as recommended by the ADA for real-time glucose tracking and management (ADA, 2022). Diabetes education on diet and lifestyle changes is validated by evidence showing improved glycemic control with proper dietary management (Martens et al., 2021). In the broader setting, this approach aims to reduce insulin spikes in 60% of diabetic patients.

Administering diuretics is appropriate for managing renal function, supported by guidelines that advocate for diuretics in treating edema and protecting kidney function (Afify et al., 2023). For the overall patient population, this strategy aims to achieve a 20% improvement in renal function by ensuring early intervention and regular monitoring. Addressing Mrs. Smith’s financial barriers to medication adherence by connecting her with financial assistance programs is supported by evidence indicating that financial barriers significantly impact medication compliance and health outcomes (Kvarnström et al., 2021). For the broader setting, ensuring 90% of patients receive financial support can help improve medication adherence and overall health outcomes.

While CGM is beneficial, some perspectives highlight that its cost and complexity could be barriers for Mrs. Smith and other patients. Additionally, focusing more on non-pharmacological interventions for renal function, such as dietary modifications, could be suggested as an alternative strategy (Karakuş et al., 2021). Emphasizing the importance of mental health support to enhance adherence and well-being is also crucial (Bingham et al., 2020). Considering these viewpoints ensures a holistic and patient-centered approach, addressing potential barriers and alternative strategies for achieving the desired outcomes.

Quality Improvement in Safety and Equitable Care through Change Strategies

CGM is the change approach most likely to lead to significant quality improvements in patient safety. By providing real-time data on blood glucose levels, CGM allows for timely adjustments in insulin administration, thereby reducing the chances of hypoglycemia and hyperglycemia. This enhances safety by preventing acute difficulties such as diabetic ketoacidosis and hyperglycemic coma, ensuring that both Mrs. Smith and other patients in the current setting maintain stable blood sugar levels (Martens et al., 2021). Administering diuretics, as supported by guidelines for treating edema and protecting kidney function, will likely improve renal function.

This strategy enhances patient safety by managing fluid retention, reducing the risk of further renal damage, and ensuring better overall renal health for Mrs. Smith and other patients in the current setting (Afify et al., 2023).Improving dietary management and increasing social engagement will enhance the quality of self-care. Providing comprehensive diabetes education and connecting patients with community resources ensures that patients like Mrs. Smith can manage their conditions more effectively, leading to fewer complications and better health outcomes.

NURS FPX 6021 Assessment 2 Change Strategy and Implementation

These strategies promote equitable care by addressing both medical and social needs, ensuring holistic support for all patients (Do et al., 2020). Addressing Mrs. Smith’s financial barriers through assistance programs and simplifying her medication regimen are strategies that will lead to quality improvements. These strategies tackle the financial obstacles preventing access to necessary medications, promoting equitable access to essential healthcare resources. Ensuring that about 90% of patients can adhere to their prescribed treatment regimens, regardless of financial constraints, supports health equity and improves health outcomes (Kvarnström et al., 2021).

These strategies also contribute to other aspects of the Quadruple Aim, including enhancing patient experience and improving the work-life balance of healthcare providers. By stabilizing conditions like Mrs. Smith’s and reducing the incidence of complications, the healthcare team can focus more on preventive care and patient education, leading to a more efficient and satisfying care process for both patients and providers (Clark et al., 2022). This approach is intended to reduce insulin spikes in 60% of diabetic patients, improve renal function by 20%, and ensure that 95% of patients can effectively self-care, thereby ensuring comprehensive quality improvement across the care setting. The explanation assumes that Mrs. Smith has access to and can use continuous glucose monitoring technology effectively. It also assumes that financial assistance programs are available and sufficient to cover her medication costs and other treatment-related expenses (Clark et al., 2022).

How Change Strategies Will Utilize Interprofessional Considerations

The proposed change strategies, particularly CGM and comprehensive diabetes education, will best leverage interprofessional considerations and strategies. Implementing CGM requires collaboration among endocrinologists, nurses, and diabetes educators to ensure Mrs. Smith understands how to use the technology and interpret the data (Martens et al., 2021). This team approach ensures that any CGM usage or glucose level management issues are promptly addressed, facilitating successful implementation. Comprehensive diabetes education involves dietitians, nurses, and social workers to provide a holistic understanding of dietary management, lifestyle changes, and available community support (Ernawati et al., 2021). This multidisciplinary collaboration ensures that Mrs. Smith receives consistent, well-rounded care and support, promoting adherence to her treatment plan.

These plans also address the well-being of healthcare workers by distributing the workload and fostering a supportive team environment. When each professional contributes their expertise, it reduces the burden on individual providers and enhances job satisfaction. This collaborative approach helps mitigate burnout and stress, contributing to a healthier, more engaged workforce (Ernawati et al., 2021). By addressing these interprofessional considerations, the change strategies ensure a cohesive and effective implementation, ultimately leading to improved patient outcomes and professional well-being. The explanation assumes that all relevant healthcare professionals are available and willing to collaborate effectively on Mrs. Smith’s care. It also assumes that adequate resources and training are available for implementing CGM and comprehensive diabetes education (Nurchis et al., 2022).

Conclusion

Implementing continuous glucose monitoring, comprehensive diabetes education, and financial assistance will significantly improve Mrs. Smith’s health outcomes. These strategies ensure patient safety and equitable care while fostering effective interprofessional collaboration. This approach promotes the well-being of both patients and healthcare professionals.

References

ADA. (2022). American diabetes association. Diabetes.org. https://diabetes.org/ 

Afify, H., Morales, U. G., Asmar, A., Alvarez, C. A., & Mansi, I. A. (2023). Association of thiazide diuretics with diabetes progression, kidney disease progression, cardiovascular outcomes, and death among patients with diabetes who initiate statins. The American Journal of Cardiology, 203, 274–284. https://doi.org/10.1016/j.amjcard.2023.07.057 

Bingham, J. M., Black, M., Anderson, E. J., Li, Y., Toselli, N., Fox, S., Martin, J. R., Axon, D. R., & Silva-Almodóvar, A. (2020). Impact of telehealth interventions on medication adherence for patients with type 2 diabetes, hypertension, and/or dyslipidemia: A systematic review. Annals of Pharmacotherapy, 55(5), 637–649. https://doi.org/10.1177/1060028020950726 

NURS FPX 6021 Assessment 2 Change Strategy and Implementation

Capella University. (2024). Capella university: Online accredited degree programs. Capella.edu. https://www.capella.edu/ 

Clark, A., Jung, E., Prusky, C., Shah, B. R., & Halperin, I. J. (2022). An evaluation of virtual care for gestational diabetes using the quadruple aim framework: assessment of patient and provider experience, cost and clinical outcomes. Canadian Journal of Diabetes, 47(3), 236–242. https://doi.org/10.1016/j.jcjd.2022.12.002 

Do, J. Y., Kim, S. W., Park, J. W., Cho, K. H., & Kang, S. H. (2020). Is there an association between metformin use and clinical outcomes in diabetes patients with COVID-19? Diabetes & Metabolism, 47(4). https://doi.org/10.1016/j.diabet.2020.10.006 

Ernawati, U., Wihastuti, T. A., & Utami, Y. W. (2021). Effectiveness of diabetes self-management education (DSME) in type 2 diabetes mellitus (T2DM) patients: Systematic literature review. Journal of Public Health Research, 10(2), 198–202. https://doi.org/10.4081/jphr.2021.2240 

Karakuş, K. E., Sakarya, S., Yeşiltepe Mutlu, G., Berkkan, M., Muradoğlu, S., Can, E., Gökçe, T., Eviz, E., & Hatun, Ş. (2021). Benefits and drawbacks of continuous glucose monitoring (CGM) use in young children with type 1 diabetes: A qualitative study from a country where the CGM is not reimbursed. Journal of Patient Experience, 8(1). https://doi.org/10.1177/23743735211056523 

NURS FPX 6021 Assessment 2 Change Strategy and Implementation

Kvarnström, K., Westerholm, A., Airaksinen, M., & Liira, H. (2021). Factors contributing to medication adherence in patients with a chronic condition: A scoping review of qualitative research. Pharmaceutics, 13(7). https://doi.org/10.3390/pharmaceutics13071100 

Laursen, J., Melo, J. B., Haddock, B. L., Larsson, H., Frimodt-Møller, M., Andersen, U. L., & Rossing, P. (2021). Acute effects of dapagliflozin on renal oxygenation and perfusion in type 1 diabetes with albuminuria: A randomized, double-blind, placebo-controlled crossover trial. EClinical Medicines, 37. https://doi.org/10.1016/j.eclinm.2021.100895 

Lin, R., Brown, F., James, S., Jones, J., & Ekinci, E. (2021). Continuous glucose monitoring: A review of the evidence in type 1 and 2 diabetes mellitus. Diabetic Medicine, 38(5). https://doi.org/10.1111/dme.14528 

Martens, T., Beck, R. W., Bailey, R., Ruedy, K. J., Calhoun, P., Peters, A. L., Pop-Busui, R., Philis-Tsimikas, A., Bao, S., Umpierrez, G., Davis, G., Kruger, D., Bhargava, A., Young, L., McGill, J. B., Aleppo, G., Nguyen, Q. T., Orozco, I., Biggs, W., & Lucas, K. J. (2021). Effect of continuous glucose monitoring on glycemic control in patients with type 2 diabetes treated with basal insulin. JAMA, 325(22). https://doi.org/10.1001/jama.2021.7444 

Nagendra, L., Fernandez, C. J., & Pappachan, J. M. (2023). Simultaneous pancreas-kidney transplantation for end-stage renal failure in type 1 diabetes mellitus: Current perspectives. World Journal of Transplantation, 13(5), 208–220. https://doi.org/10.5500/wjt.v13.i5.208 

NANDA. (2020, October 6). NANDA International Nursing Diagnoses | NANDA International, Inc. NANDA. https://nanda.org/publications-resources/publications/nanda-international-nursing-diagnoses/ 

Nurchis, M. C., Sessa, G., Pascucci, D., Sassano, M., Lombi, L., & Damiani, G. (2022). Interprofessional collaboration and diabetes management in primary care: A systematic review and meta-analysis of patient-reported outcomes. Journal of Personalized Medicine, 12(4). https://doi.org/10.3390/jpm12040643 

Sugandh, F. N. U., Chandio, M., Raveena, F. N. U., Kumar, L., Karishma, F. N. U., Khuwaja, S., Memon, U. A., Bai, K., Kashif, M., Varrassi, G., Khatri, M., Kumar, S., Sugandh, F., Chandio, M., Raveena, F. N. U., Kumar, L., Karishma, F. N. U., Khuwaja, S., Memon, U. A., & Bai, K. (2023). Advances in the management of diabetes mellitus: A focus on personalized medicine. Cureus, 15(8), 1–13. https://doi.org/10.7759/cureus.43697